ESCRS - FP19.06 - Transepithelial Accelerated Corneal Collagen Crosslinking In Patients With Keratoconus: Is Oxygen Supplementation Beneficial?

Transepithelial Accelerated Corneal Collagen Crosslinking In Patients With Keratoconus: Is Oxygen Supplementation Beneficial?

Published 2025 - 43rd Congress of the ESCRS

Reference: FP19.06 | Type: Free paper | DOI: 10.82333/7arb-3x69

Authors: Mahmoud Farouk* 1 , Amr Mounir 1 , Mortada Ahmed Abozaid 1 , Engy Mohamed Mostafa 1 , Marwa Mahmoud Abdellah 1

1Sohag University,Sohag,Egypt

Purpose

To systematically evaluate the efficacy and safety of transepithelial accelerated corneal crosslinking (TE-ACXL) with and without oxygen supplementation (TE-ACXL-O2) in patients with progressive keratoconus over a 12-month period.

Setting

Single-center  retrospective study conducted at Unidade Local de Saúde de São João, a tertiary university hospital from Porto, Portugal.

Methods

This study included 68 eyes from 110 patients with progressive keratoconus, of which 35 underwent TE-ACXL (6mW/cm² for 15 minutes) and 33 underwent TE-ACXL-O2. Best-corrected visual acuity (BCVA), maximum keratometry (Kmax), minimum pachymetry (PachyMin) and topometric indices were assessed preoperatively and at 12 months postoperatively. Statistical comparisons were performed for baseline and postoperative differences within and between groups (Δ=difference).

Results

Preoperative parameters were comparable between groups (p>0.05).  Within-group comparison between preoperative and 12-month postoperative readings demonstrated that: ΔBCVA(TE-ACXL -0.04±0.02 logMAR units, p=0.214 vs. TE-ACXL-O2, 0.00±0.09 logMAR units, p= 0.442), ΔKmax (TE-ACXL, 0.4±0.1D, p=0.211 vs. TE-ACXL-O2, +0.76±0.23D, p=0.019), ΔPachyMin (TE-ACXL, -1.7±1.2 µm, p=0.447 vs. TE-ACXL-O2, -10.66±18.1 µm, p=0.006), ΔISV (TE-ACXL, 0.1±2.85, p=0.941 vs. TE-ACXL-O2, 3.01±0.61, p=0.046), ΔIVA (TE-ACXL, -0.04±0.02, p=0.362 vs. TE-ACXL-O2, -0.02±0.01, p=0.289), ΔIHD (TE-ACXL, 0.00±0.00, p=0.526 vs. TE-ACXL-O2, 0.01±0.003, p=0.012).

Conclusions

Both TE-ACXL and TE-ACXL-O2 effectively stabilized keratoconus progression over 12 months, with no clinically significant improvement or deterioration observed in either group. While TE-ACXL-O2 showed statistically significant changes in Kmax and PachyMin, their clinical relevance is limited. Topometric indices showed a trend toward improvement. Given that the primary goal of crosslinking is to halt progression, these findings suggest that both techniques appear equally effective in maintaining corneal stability, with oxygen supplementation providing no meaningful clinical advantage. Furthermore, no adverse effects were observed with either technique, reinforcing their safety.